急性缺血性脑卒中的进展与脑血管狭窄的关系  

The relationship between progression of ischemic stroke and cerebral artery stenosis

作　　者：李霞[1] 乔淑冬[1] 范常锋[1] LI Xia QIAO Shu-dong FAN Chang-feng(Department of Neurology, Peking University Shougang Hospital, Beijing 100144, China)

机构地区：[1]北京大学首钢医院神经内科,北京100144

出　　处：《中国医刊》2016年第12期43-45,共3页Chinese Journal of Medicine

摘　　要：目的探讨不同TOAST病因亚型中,进展性脑卒中与脑血管狭窄的关系。方法选择2014年9月至2016年2月期间于本院住院的急性大脑半球缺血性脑卒中患者209例,所有患者均在发病24小时内入院,并根据斯堪的纳维亚评分标准将患者分为进展性脑卒中和非进展性脑卒中,记录患者入院后头颅MRI、头颈CT血管造影及TOAST病因分型。结果入组209例患者,发生进展性脑卒中49例(23.4%)。进展性脑卒中的发生率在心源性栓塞型最高,为36.4%,其次为大动脉粥样硬化型(30%),小动脉闭塞型为(15.9%)。大动脉粥样硬化型中伴有大脑中动脉重度狭窄或闭塞的患者进展性脑卒中的发生率最高为46.4%,其次为伴有颈内动脉重度狭窄或闭塞患者(26.9%),发生率最低者为大脑中动脉或颈内动脉中度狭窄患者,为15.4%(P<0.05)。而对于小动脉闭塞型,进展性脑卒中发生率与大动脉狭窄无关(P>0.05)。结论对大动脉粥样硬化型患者,进展性脑卒中的发生率与大动脉狭窄程度和部位有关;而小动脉闭塞型脑卒中的进展与大动脉狭窄无关。Objective To analyze whether cerebral artery stenosis plays a role in ischemic stroke progression.MethodBetween September 2014 and February 2016, 209 patients with hemisphere ischemic stroke after onset in 24 hours were included in our study. They were divided into progressive stroke group and non-progressive stroke group according to Scandinavian Stroke Scale. The type of ischemic stroke was analyzed by the criteria of Trial of Org 10 172 in Acute Stroke Treatment （TOAST）. Cerebral MRI and cranio-cervical CTA were recorded.ResultData of 209 patients with acute ischemic stroke was collected. Of them, 49 patients （23.4%） developed into progressive stroke. The highest incidence of progressive stroke is observed in the type of cardioembolism （36.4%）, which was followed by large-artery atherosclerosis （30%） and small-vessel occlusion （15.9%）. The highest incidence of progressive stroke in the type of large-artery atherosclerosis was observed in patients with severe stenosis or occlusion in Middle Cerebral Artery （46.4%）, which was followed by patients with severe stenosis or occlusion in Internal carotid artery （26.9%）. The lowest incidence was observed in patients with moderate MCA or ICA stenosis （15.4%,P〈0.05）. No relationship was found between small-vessel occlusion type and large arterial stenosis （P〉0.05）.ConclusionLarge arterial stenosis is related to progressive stroke with large-artery atherosclerosis, and is not related to progressive stroke with small-vessel occlusion.

关 键 词：缺血性脑卒中 TOAST病因分型 脑血管狭窄 

分 类 号：R743[医药卫生—神经病学与精神病学]